Forms Library

Forms produced by the Wisconsin Department of Health Services are available for downloading and printing. If a form is not available electronically, you will be provided instructions for requesting a paper copy. When you are searching for a form, just enter the number in the search box below.

Assigned Numbersort ascending Title Division Other Location
F-20812 SSI-E Natural Residential Setting Application Checklist DMS
F-20691 Request for Exemption - Intoxicated Driver Program (IDP), Employment of Individuals with Lesser Qualifications DCTS
F-20582 Medicaid – Katie Beckett Program Application DMS
F-20572 Request for State Public Funding for Non-Residents DCTS
F-20483 Wisconsin Incident Tracking System (WITS) Web Access Request DPH
F-20448 Request for Medicaid Administrative Funds – Staff Position DMS
F-20445A Individual Service Plan - Outcomes - Children’s Long-Term Support Programs DMS
F-20445 Individual Service Plan – Children’s Long-Term Support Programs DMS
F-20441Ai Adult-At-Risk Abuse, Neglect, and/or Exploitation Valid Values DPH
F-20441A Adult-At-Risk Abuse, Neglect, and/or Exploitation Data Collection DPH
F-20418 Agency Application for Access to Web-Based Personal Care Screening Tool DMS
F-20389 DCTS Program Performance Report DCTS
F-20224 Office for the Blind and Visually Impaired Assessment / Plan / Evaluation DPH
F-20009 Complaint Report DCTS
F-19002 Request to Reduce QUEST Card Balance DMS
F-16104 Local Agency Customer Feedback DMS
F-16076 FoodShare Six-Month Report and Instructions DMS
F-16073 FoodShare Wisconsin Nonfinancial Worksheet DMS
F-16066 FoodShare Wisconsin Income Change Report DMS
F-16039 Waiver of Administrative Disqualification Hearing DMS
F-16038 Administrative Disqualification Hearing Notice DMS
F-16036 Self-Employment Income Worksheet: Partnership (Schedule K-1 [Form 1065] and Form 1065) DMS
F-16035 Self-Employment Income Worksheet: S Corporation (Schedule K-1 [Form 1120S] and Form 1120S) DMS
F-16033 FoodShare Worksheet DMS
F-16031 Student Aid and Expense Worksheet DMS
F-16030 FoodShare Wisconsin Under / Overissuance Worksheet and Overpayment Calculator DMS
F-16029 FoodShare Wisconsin Repayment Agreement DMS
F-16028 Notice of FoodShare Overissuance DMS
F-16026 Prosecution Diversion Agreement DMS
F-16025 Disqualification Consent Agreement DMS
F-16024 FoodShare Notice of Disqualification DMS
F-16023 Striker Evaluation DMS
F-16022 Social Security Number Referral DMS
F-16021 Student Financial Aid Report DMS
F-16019B FoodShare Wisconsin Registration Packet DMS
F-16019A FoodShare Wisconsin Registration DMS
F-16015 Notice of Approval of Benefits/Positive Change in Benefits DMS
F-16014 Notice of Program Violation DMS
F-16004 Add or Remove an Authorized Buyer or Alternate Payee for FoodShare Benefits DMS
F-16001 Notice of Denial of Benefits/Negative Change in Benefits DMS
F-14014 Authorization to Disclose Information to Disability Determination Bureau (DDB) DMS
F-13509 Wisconsin Well Woman Program Provider Certification OIG
F-13470 Claim Form Attachment Cover Page DMS
F-13393 Trading Partner 835 Designation DMS
F-13168 Wisconsin SeniorCare HIPAA Privacy Restriction Request DMS
F-13167 Wisconsin SeniorCare HIPAA Privacy Revocation of Authorization DMS
F-13166 Wisconsin SeniorCare HIPAA Privacy Complaint DMS
F-13165 Wisconsin SeniorCare HIPAA Privacy Amendment Request DMS
F-13164 Wisconsin SeniorCare HIPAA Privacy Alternate Communication Request DMS
F-13163 Wisconsin SeniorCare HIPAA Privacy Accounting Request DMS

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Last Revised: March 23, 2021